I first had an inkling of trouble when the call bell rang and all we heard from the intercom was a scuffling noise. One of the physical therapists and I went into the room as quickly as we could, hustling our little butts, and found fists, and nurses dancing and feinting like Ali, and general chaos.
He'd been a rancher all his life. We don't grow people like this any longer: well over six feet tall even in his seventies, never drank or smoked, never sick a day in his life until his aneurysm bled. The bleed had unfortunately affected only his personality and not his body; he was standing, bleeding from where he'd tried to remove the second Foley catheter, screaming, "GODDAMMIT! I'll KILL you! Let GO OF ME!!"
He's a strong sonofabitch, I'll tell you that. Two nurses got his arms--staying well away from his hands, as he'd already tried to break one nurse's wrist and another one's finger--and I put a shoulder into his belly and shoved him onto the bed. Once we got him into restraints, one on each limb, and a vest, he continued to fight. The bed shook and creaked and groaned until his nurse got some Ativan into him.
The irony is that we knew him from before, when his wife came in for surgery. He was (before the bleed) the sweetest man you'd ever hope to meet. Polite, courtly, took good care of his family. Now he's trying to get out of the hospital, pulling out multiple lines, and punching security guards in the face.
Later, one of the nurses asked me about the amount of force that's acceptable when you're subduing a combative patient. She was in there with one other person when he started to go berzerk, and was merely staying out of his way as best she could, dodging his punches and kicks.
"I was afraid to grab his arm or put him on the floor, because I was afraid I might hurt him" she said. Now, this is a tiny woman--smaller than me--who spent the first half of her life in very rough neighborhoods. She's taken punches from patients before with no more than a blink.
"Lou," I said, "whatever amount of force is necessary, without breaking bones, you use. If somebody is trying to hurt you, the objective is to get them tied down and sedated before they can manage to break something of yours." Hence my shoulder-in-the-solar-plexus trick: I've found it works well with a distracted, combative patient.
It doesn't work so well with the oriented, mean patient. One of our nurses is out following surgery for a broken neck that a patient broke on purpose.
The woman weighed close to five hundred pounds and was, put simply, meaner than Satan. When the nurse taking care of her got close enough one day, she simply reached out, grabbed the nurse's head, and pulled. Score: nurse with cervical fractures, patient refused services forever.
Luckily, the nurse will be fine. The patient? I don't give a damn.
I woke up this morning sore and exhausted and couldn't remember why I was so achy. Then it hit me--I'd spent several minutes riding a bucking bronco of a man down onto a bed, then holding his legs down.
Nursing. It's glamorous! It's exciting! It's the toughest job you'll ever lay in stores of Advil for.